Payroll Services Letter - Program Support Center

Payroll Services Letter
Number: PS05-09.2
Date: June 16, 2008 (Revised May, 2009)
Subject: Debt Collections
Category: Debt Management
________________________________________________________________
Reference: PS05-09.1, Subject: Debt Collections dated June 16, 2008. PS05-
09.2 supersedes PS05-09.1. Please replace that letter with this one.
Purpose
This letter is to inform the Department of Health and Human Services (HHS) Human
Resource (HR) Centers and Operating Divisions (OPDIV) of payroll procedures for debt
collections. The changes will be implemented as part of the conversion of the HHS
payroll system to the Defense Civilian Pay System (DCPS) operated by the Defense
Finance and Accounting Service (DFAS), our new payroll provider.
The DFAS Cleveland (DFAS-CL) Payroll Office will notify employees directly
regarding employee debts.
Debt collections fall into one of four categories:
A. Salary Debts
B. Administrative and Non-Salary Debts
C. Court Ordered Garnishments
D. Separated Employee Salary Debts
Salary Debts
_ _ _ _ _ _ _ _ _ _ _ _
Salary debts can occur when time and attendance information is corrected or changed for
a previous pay period or when retroactive personnel actions are processed that changes
the salary or pay entitlements. This includes any overpayment that is attributable to
clerical errors, administrative errors, or delays in processing pay documents. This also
includes Health Benefits debts for employees who are on leave without pay (LWOP) or
who have insufficient salary to cover health benefits premiums. Salary debts are
classified as either routine debts or non-routine (full due process) debts.
PS05-09.2 Page 1 of 18

Routine Debt
A routine debt is defined as a salary overpayment having an amount of $50.00 or less, or
one that is greater than $50.00 but is identified within four pay periods. The collection
of a routine debt will begin in the pay period that it is identified by the payroll office.
There will not be a delay in starting the collection of newly identified routine debt. A
remark will appear on the Leave and Earnings Statement (LES) in the pay period the
collection is started. The remark will include the amount being collected in the current
pay period, the gross amount of the debt, what caused the debt (time and attendance or
personnel action) and a contact phone number for the DFAS debt processing team.
The following is an example of a remark that may appear on the LES for each deduction
taken:
$__________COLLECTED THIS PAY PERIOD FOR $__________.___ (LESS
AMT APPLIED LEAVES A REMAINING BALANCE $__________.___)
_______________________ CORRECTION DEBT IN ACCORDANCE WITH
DEBT COLLECTION IMPROVEMENT ACT OF 1996. POC: PAYROLL
OFFICE CUSTOMER SERVICE DESK, 1 (800) 729-3277.
The deduction amount may not exceed 15 percent of disposable net pay unless the
employee gives written consent. If the total amount of the debt exceeds this limitation,
the initial deduction will be for the full 15 percent and remaining deduction amounts will
be 15 percent until the debt has been satisfied.
Non-Routine Debts
A non-routine debt is any salary overpayment greater than $50 that was not identified
within four pay periods in which the debt was incurred. This is considered a debt
requiring full due process. Due process includes giving the employee written
notification, which includes information about submitting payments, and the employee’s
rights to request a hearing or a waiver.
If the employee does not repay the debt or contact the payroll office to establish a
repayment schedule within 30 days, the DFAS-CL Payroll Office will begin collection of
the debt by salary offset at 15 percent of their disposable net pay.
The following is an example of a remark that may appear on the LES for each deduction
taken:
$__________COLLECTED THIS PAY PERIOD FOR $__________.___ (LESS
AMT APPLIED LEAVES A REMAINING BALANCE $__________.___)
_______________________ CORRECTION DEBT IN ACCORDANCE WITH 5
U.S.C. 5514. POC: PAYROLL OFFICE CUSTOMER SERVICE DESK,
1 (800)729-3277.
PS05-09.2 Page 2 of 18

Health Benefit Debts
During periods of leave without pay or insufficient pay, employees participating in the
Federal Employees Health Benefits Program (FEHB) are indebted for the amount of the
employee’s portion of the FEHB premiums.
Collection for FEHB debts will be for the current pay period and one prior pay period
until the debt is paid in full.
There are various remarks that appear on the LES for FEHB Debts. Below are some of
these remarks:
• CASH PAYMENT PROCESSED FOR FEHB
o This remark is produced when a payment for FEHB indebtedness is
processed.
• FEHB PREMIUM HAS BEEN PREPAID BY YOUR AGENCY DUE TO
INSUFFICIENT PAY. THIS DEBT MUST BE REPAID EXCEPT FOR THOSE
ELIGIBLE RESERVISTS IN SUPPORT OF CONTINGENCY OPERATIONS.
o This remark is produced when an employee has insufficient funds during
any pay period to pay the employee’s portion of the FEHB premium. The
agency is automatically charged for the employee’s portion of the
premium.
• PREPAID FEHB PREMIUM DEBT COLLECTED
o This remark is produced when an employee has a deduction or adjustment
for FEHB that was previously paid by the agency.
• RETROACTIVE ADJUSTMENT(S) FOR HEALTH BENEFITS PROCESSED
o This remark is produced when an automatic collection for FEHB
indebtedness is processed.
Repayment Options
These options normally apply to non-routine debts. However, an employee may submit
payment in full for routine debts, if they wish. The DFAS-CL Payroll Office must be
notified that payment in full has been submitted, with the date and amount of the payment
so the automatic payroll deduction can be stopped.
The employee can consent to pay the debt voluntarily or the Government can collect the
debt involuntarily.
Voluntary Repayment
There are two methods for repaying a debt voluntarily:
PS05-09.2 Page 3 of 18

1) A payment can be made by check or money order. The payments can be paid
in one lump sum or at regularly established intervals. Checks or money orders
for repayment of debts should have the employee’s SSN and “Debt Payment”
written on the check and be made payable to DFAS-CL DSSN 8522 and
mailed to:
DFAS-CL
P.O. Box 99559
Cleveland, OH 44199
2) The debt can be collected through payroll deduction using one of the
following methods.
a) A one-time deduction.
b) Payment may be spread over more than one pay period for other than
minor indebtedness amounts. The debt should be equal to at least 15% of
the disposable pay in order to qualify for installment liquidation.
Installment payments must be at least $25 per pay period and must be
sufficient to liquidate the debt within three years. All installment
payments that are less than 25% of the employee’s disposable net pay
must be approved by the designated agency representative.
Involuntary Repayment
Recovery of the indebtedness by involuntary salary offset is for instances in which the
employee has failed to either make a payment, authorize a voluntary one-time payroll
deduction, or enter into an agreement with the payroll office for installment deductions.
(see Attachment A – sample – Debt Collection Letter for Formal Due Process Debts)
Waiver and Hearing Requests
Waiver and hearing requests should be submitted by the employee to their HR Center.
Employee instructions for requesting waivers and hearings are found in Attachment B of
this letter and on the HHS Intranet Forms website
at:http://intranet.hhs.gov/forms/hhs_forms.html
PS05-09.2 Page 4 of 18

Hearing Request
If an employee has reason to believe he or she was not overpaid or the amount of the debt
is incorrect, the employee may submit a written request for review by a hearing officer
within fifteen calendar days from the date of mailing of the notice. The request must
raise a genuine issue of fact or law.
Waiver Request
Under certain circumstances, debt claims against an employee may be waived. Authority
is provided by 5 USC 5584 and 4 CFR, parts 91 and 92, for the waiver of claims of the
United States against an employee stemming from an erroneous payment of pay or
allowances.
It is the employee’s responsibility to review his/her LES and make an inquiry as to any
unexplained increases in their pay and allowances.
The employee may request a waiver of the overpayment if he/she believes that the
overpayment occurred through administrative error and the employee was not aware of
the error through receipt of any official document/notification.
Amounts collected and later waived or found not owed will be promptly refunded to the
employee unless otherwise provided by the statue or contract.
Submission Requirements
If an employee decides to apply for a waiver or hearing, he or she should follow the
instructions for Request for Waiver of Overpayment or for Hearing (DHHS), Attachment
B, and send the request to the HR Center. The request for waiver or hearing should
include the reason for the request, whether the employee was aware or unaware of the
overpayment, whether the employee put forth any effort to question the overpayment, and
an actual request for a refund if the waiver is granted.
Suspension of Collection
DFAS will suspend collection of the debt pending waiver determination only if the
OPDIV representative or HR Center requests suspension in writing.
PS05-09.2 Page 5 of 18

The address is:
DFAS Cleveland
Civilian Payroll Office
8899 E 56 th Street
Indianapolis, IN 46249-1900
The fax number is:
Toll Free: 1 (866) 401-5849
Commercial: 1 (317) 275-0354
Hearing and Waiver Decision
The employee will be directly notified of the hearing and waiver decision. A copy of the
decision letter will also be forwarded to the DFAS-CL Payroll Office. The DFAS-CL
Payroll Office is responsible for processing refunds of any amount collected and
subsequently waived. The DFAS-CL Payroll Office must immediately initiate further
collection action when informed of a waiver denial and collection action has been
suspended.
Administrative and Non-Salary Debts
Administrative and Non-Salary debts are monies owed to the OPDIV or other
Government agencies by employees. Examples include: recovery for travel advances,
equipment, student loans, training, salary advances, emergency salary advances, and
other Government agency debts.
Debts owed to OPDIVS
In order for an OPDIV to request recovery of a debt, they must submit the request to the
DFAS-CL Payroll Office along with the Request for Recovery of Debt Due the United
States by Salary Offset form (see Attachment C). This form is used for requesting
recovery of a debt by salary offset and certifying that due process has been completed.
The collection is processed through the employee’s payroll record, and the specified
amount is withheld from the employee’s pay in single or multiple deductions.
The request form must be sent directly to the DFAS-CL Payroll Office via the DFAS
Imaging Center. For more information on sending documents to DFAS-CL Payroll
Office, see the Imaging Documents Payroll Letter. For more information on how to
properly prepare the form, see PS05-02.1, Agency Administrative Offset Letter.
PS05-09.2 Page 6 of 18

The address is:
DFAS Cleveland
Civilian Payroll Office
8899 E 56 th Street
Indianapolis, IN 46249-1900
The fax number is:
Toll Free: 1 (866) 401-5849
Commercial: 1 (317) 275-0354
Debts Owed to Other Government Agencies
When federal agencies notify HHS of outstanding employee debts owed to their agency,
the request for collection should be forwarded to the DFAS-CL Payroll Office via the
DFAS Imaging Center using the revised form DD2481 – Request for Recovery of Debt
Due the United States by Salary Offset. The address is:
DFAS Cleveland
Civilian Payroll Office
8899 E 56 th Street
Indianapolis, IN 46249-1900
The fax number is:
Toll Free: 1 (866) 401-5849
Commercial: 1 (317) 275-0354
These debts may automatically be collected by salary offset through the Treasury Offset
Program (TOP). With each deduction taken the LES remark will state:
$_(deduction amount) COLLECTED THIS PAY PERIOD FOR A $_(gross amount)_
TREASURY OFFSET PROGRAM DEBT. CONTACT THE TOP CALL CENTER AT
1-800-304-3107 FOR MORE INFORMATION.
Additional remarks may be found on the employee’s LES for the collection of other
government agency debts.
PS05-09.2 Page 7 of 18

Court Ordered Garnishments
Garnishments and bankruptcies are types of court ordered debts.
Garnishments:
There are garnishments for 1) child support and alimony and 2) commercial debts.
DFAS Cleveland is the official record keeper for all of these documents and is
responsible for processing them. Employees are instructed to contact DFAS Cleveland
directly with questions concerning garnishments.
Inquires and court orders should be sent to:
DFAS-CL
Code L
PO Box 998002
Cleveland, OH 44199-8002
Or call:
Toll Free: 1 888-332-7411
For commercial debts, which include state and local indebtedness, a one time
administrative fee of $75.00 per case shall be collected from the amount of the
garnishment due to the creditor. The administrative fee will be collected in full before
any payments are remitted to the creditor. An administrative fee will be assessed for each
case if more than one commercial debt exists.
Bankruptcy:
Federal employees may file for bankruptcy under the provisions of 11 U.S.C. The court
orders are sent to the DFAS-CL Payroll Office. The DFAS-CL Payroll Office processes
the collection in accordance with the instructions in the court order.
Debt collection inquiries from HR Centers on behalf of employees can be sent using
the Peregrine system. The category is: DEBT COLLECTIONS and the subcategory is
the type of debt such as: AGENCY DEBTS, BANKRUPTCY, IRS LEVIES, or
SALARY OVERPAYMENTS. Inquiries can also be sent to the DFAS-CL Payroll
Office via the Imaging Center. The address is:
DFAS Cleveland
Civilian Payroll Office
8899 E 56 th Street
Indianapolis, IN 46249-1900
The fax number is:
PS05-09.2 Page 8 of 18

Toll Free: 1 (866) 401-5849
Commercial: 1 (317) 275-0354
D. Separated Employee Salary Debts
Separated Employee Salary Debts for Former HHS Employees
The Program Support Center’s (PSC), Financial Management Services (FMS) Debt
Management Branch will continue to collect debts for employees who separate from
HHS. (see Attachment D – Debt Collection Letter for Separated Employee Debts).
If you have questions regarding the information contained in this letter, please contact
your Payroll Customer Service Team.
PS05-09.2 Page 9 of 18

Attachment A
SAMPLE
DEBT COLLECTION LETTER FOR FULL DUE PROCESS (NON-ROUTINE) DEBTS
Each Payroll Office
Letterhead here
(2A)Name
(2B)Street
City, State Zip
(1)DATE: Month date, year
Dear Name:
An overpayment record has been generated on your pay account for pay period(s) ending
________________(20). The gross amount of your overpayment (including pay, all taxes, benefits and
other deductions) is ____________(5). The overpayment is the result of
__________________________(4)change(s).
Under the provisions of 31 CFR 901.2, payment of this debt is due within 30 days from the date of
this letter. Your repayment options are:
a. You may remit the repayment in the net amount of $__________(6) by check or
money order payable to DFAS-CL DSSN ____(7), along with the payment coupon at the bottom of this
letter to DFAS-CL, P.O. Box 99555, Cleveland OH 44199.______________________________(8).
b. If you are unable to remit payment in full, you may submit the enclosed Voluntary
Repayment Agreement to your civilian payroll office at the address on the letterhead above.
c. If you do not repay the debt in full or establish a voluntary repayment schedule within
____(9) days, we are required to collect the debt involuntarily from your pay, beginning on
___________(10). The maximum amount deductible under these circumstances is 15 percent of your
disposable pay each pay period until the debt is repaid in full. Our estimates of your disposable pay, based
on current payroll information, is $__________(11). Therefore, the maximum deduction would be
$__________(12), and repayment of the principal amount of the debt would take approximately _____(13)
pay periods.
We encourage your prompt payment as in accordance with 4 CFR 102. 13 and 31 USC 3717,
interest at the Treasury tax and loan rate, penalties and administrative fees, may be assessed from the date
of this letter on any part of the debt not paid within _____(9) days of the date of this letter.
You may request copies of records we hold pertaining to your debt by contacting this office.
If you have any questions about your debt you may contact your timekeeper for time and
attendance corrections, or your personnel office for changes in personnel items or allowances. For general
questions your Customer Service Representative (CSR) can either assist you or contact this office to obtain
information relative to your needs. Your CSR cannot answer questions on debts more than 12 months old.
Contact the payroll office Customer Service Desk, at (comm phone number), DSN (DSN prefix)(14) for
action.
You may request a hearing concerning the amount, validity of the debt, or the repayment schedule.
A hearing only determines the validity of the debt and has no bearing on your ability or responsibility to
PS05-09.2 Page 10 of 18

epay the debt. Should you choose to exercise this option, please submit your written request within 30
days from the date of this letter to your civilian payroll office. Please include a statement and any
supporting documents contesting the validity of the debt. Detailed guidance regarding hearings for
erroneous payments under the authority of 5 USC 5514 are contained in regulations of the employing
agency. ___________________ new fill-in-the-blank contains the agency’s web site.
You may also request a waiver of repayment of the debt if you acknowledge the validity of the
debt, but believe you should not be required to repay it. Although collection of your debt may continue
after receipt of your waiver request, any amount collected by this office that is later waived will be
refunded to you. Detailed guidance regarding waiver of claims for erroneous payments under the authority
of 5 USC 5584 are contained in regulations of the employing agency. ___________________ new fill-inthe-blank
contains the agency’s web site.
Federal Statute 31 USC 3716 also requires that if you retire or resign before your debt is paid in
full, your final pay (salary and lump sum payments) may be applied to liquidate your debt balance without
further notification.
Sincerely,
(Signature Name)(15)
Supervisor, Debt Processing
_______________________________________________________________________
Please remit with payment:
Name___________(2A)___________________________ SSN____(17)____ PayBlk_(18)___ Code_(19)_
Debt Dates_______(20)________ Debt Type_____(4)_____________ Creation Date ____(3)____
Sequence Number___(21)______
LOA__________(22)______________________________________________________
_______________________________________________________________________
Payment Amount Enclosed $______(23)____________.
PS05-09.2 Page 11 of 18

Voluntary Repayment Agreement for Civilian Payroll Indebtedness
I understand that I owe the amount indicated below due to a salary overpayment. Should I fail to return this
repayment agreement, 15 percent of my disposable pay will be deducted beginning in the stated pay period.
An estimate of this amount is shown below.
I also understand that if I decide to repay the amount owed by any method other than in a lump sum
payment, interest at the Treasury tax and loan rate may be charged on the unpaid balance every month until
the debt is paid in full.
Please sign and return this repayment agreement to your payroll office.
Debt Reason
Allowance (4)
Sequence Number 12345 (21)
Amount Owed $357.11 (6)
Est. Disposable Net Amount $700. 00 (11)
Est. Deduction Amount 15% of net disposable $105. 00 (12)
PPE Deductions will begin July 1, 2008 (10)
Code_(19)_ Debt Dates_______(20)________ Creation Date ____(3)____
LOA__________(22)______________________________________________________
_______________________________________________________________________
Employee's Name (2A) SSN: (17) Pay Blk (18) DB___ JANE
C. SMITH 111-11-1111 301 ZFR
I choose the following repayment plan (Check one):
1. I am repaying what I owe in a lump sum. My payment in the amount of $______________is enclosed.
2. Deduct from my salary the total amount in pay period ending _____.
3. I do not want to pay it all at once. You may deduct $_________________ each pay period, which is
more than 15 percent of my disposable pay.
**4. I am unable to pay 15 percent of my disposable pay because of a financial hardship. You may deduct
$__________ each pay period. This repayment amount has been approved by my employing agency.
(Signature of agency approving official is required below).
Signature: __________________________________ Date: _________________
Daytime Telephone Number: _____________________________
**Approving Official's Signature/Date:_________________________________
PS05-09.2 Page 12 of 18

Attachment B
Request for Waiver of Overpayment or for Hearing (DHHS)
INSTRUCTIONS
PLEASE CAREFULLY READ THE FOLLOWING INFORMATION BEFORE
COMPLETING THE REQUEST FOR WAIVER OF OVERPAYMENT OR
HEARING ON PAGE 2 OF ATTACHMENT B
The Secretary shall collect on any claim of the United States for money or property
arising out of the activities of the Department of Health and Human Services. 31 U.S.C.
§ 3711(a). Any debt owed to the Department of Health and Human Services may be
collected through administrative offset or wage garnishment. 31 U.S.C. § 3716(a); 31
U.S.C. § 3720D. However, if an employee disputes the debt or the amount of the debt,
he or she may make a timely written request for a hearing before any collection efforts
are made. 45 C.F.R. § 30.15; 45 C.F.R § 32.5. Such a hearing, at the Department’s
option, may be oral or written. 45 C.F.R. § 32.5. The employee may also request to have
the debt waived if it arose due to an administrative error. 5 U.S.C. § 5584(a).
The Secretary may waive a claim of the United States against an employee arising out of
an erroneous payment of pay or allowances if the collection would be against equity and
good conscience and not in the best interest of the United States. 5 U.S.C. § 5584(a).
Should you wish to file a request for a waiver of overpayment or request a hearing
regarding your indebtedness to the Department of Health and Human Services, check the
appropriate space on the attached request form. Attach a separate statement specifying
which decision you are disputing and explaining the reasons for the dispute to this
request. You must also list any desired supporting witnesses and include any documents
to support your request. Upon completion of this form, sign it, attach any supporting
documents, and present all documents to your current Servicing Personnel Officer, or if
you are a former employer, to your former Servicing Personnel Officer. Waiver of
overpayment requests submitted by headquarters employees of the Office of the
Secretary (OS) will be forwarded to the General Law Division of the Office of the
General Counsel for review. Hearing requests will be forwarded to the Departmental
Appeals Board for review. Waiver requests submitted by OS regional employees will be
forwarded to the appropriate regional chief counsel’s office. Waiver requests for
employees working in the DHHS Operating Divisions (OPDIV) will be reviewed by the
employee’s employing operating Division.
PRIVACY ACT NOTICE
This notice is provided pursuant to Public Law 93-579, Privacy Act of 1974, 5 U.S.C. Section 552a, for individuals supplying information for a
waiver/hearing request.
Authority: This information is solicited pursuant to one or more of the following provisions: 5 U.S.C. § 5514, 31 U.S.C. § 3720D, 31 U.S.C. § 3716(a),
45 C.F.R § 30.15, and 45 C.F.R § 32.5. Disclosure of the requested information is voluntary, but necessary for processing.
Purposes and Uses: The primary use of the information supplied on this form is for evaluating claims arising out of an erroneous payment of pay or
allowance. This information may be disclosed to the (1) Department of Justice for litigation or further administrative action; (2) to the Treasury
Department; and (3) other agents of the Department of Health and Human Services to assist with collecting or compromising a debt. Social Security
numbers are requested to identify the employee and the debt owed to the Department.
Effects of Nondisclosure: Failure to supply the information will result in denial of a request.
PS05-09.2 Page 13 of 18

Request for Waiver of Overpayment or for Hearing (DHHS)
Instructions: Please carefully read the instructions on the reverse side of this form
before completing the information below, and attach the information described in
the instructions when you present your request.
____________ I dispute the debt and/or the amount owed to the Department of
Health and Human Services and request a hearing pursuant to the administrative wage
garnishment and offset provisions. 45 C.F.R. § 32.5; 45 C.F.R. § 30.15. This hearing
request has been submitted within fifteen days from the date of the collection notice.
____________ I request a waiver of overpayment pursuant to 5 U.S.C. § 5584(a),
because the overpayment occurred through an administrative error, and I was not aware
of the error and could not have reasonably been expected to have known of the error
through receipt of any official document e.g. Leave and Earnings Statements,
Notification of Personnel Action, SF-50 etc. I am aware that I am not entitled to a
hearing under the waiver provision. A separate statement explaining the overpayment
and the reason(s) for my dispute is attached.
____________ I do not request a waiver of overpayment pursuant to 5 U.S.C. §
5584(a). However, I am requesting that any administrative charges and/or interest
incurred due to my indebtedness be waived because the overpayment occurred through an
administrative error. I was not aware of the error and could not have reasonably been
expected to have known of the error through receipt of any official document, e.g. Leave
and Earnings Statements, Notification of Personnel Action, SF-50), etc. A separate
statement explaining the overpayment and the reason(s) for my dispute is attached.
Employee Name ______________________________SSN:____________________
Signature_____________________________________Date___________________
Completed by the Servicing Personnel Office only
Date Received __________Name ____________________Telephone Number ____________
HR Center __________________________________ For OPDIV _______________________________
PS05-09.2 Page 14 of 18

Guidelines for Completing the DD2481
Attachment C
SECTION 1: PAY AGENCY IDENTIFICATION
a. Name – DFAS- Cleveland
b. Address – 1240 E 9 th St, Rm 2381
Cleveland, OH 44199
SECTION 2: EMPLOYEE IDENTIFICATION
a. Name – Last Name, First Name, Middle Initial
b. Address – Employee’s complete mailing address
c. Date of Birth
d. Social Security Number – please include the complete number and not the last 4 digits
SECTION 3: DEBT INFORMATION
a. Reason for the Debt – self explanatory
b. Date right to collect accrued – date the debt was generated
c. Debt identification number, if any – maybe the employee’s SSN or some identifying
information
d. Original debt amount – self explanatory
e. Number of installation – set amount or 15% of disposal pay
f. Interest due – self explanatory
g. Penalty due – self explanatory
h. Administrative cost – self explanatory
i. Total collection to be made – self explanatory
j. Commence deductions on – effective date that collection will start
SECTION 4: DUE PROCESS
a. Creditor component 30 day salary offset notice – day the employee was notified of
the overpayment
b. Employee did not respond – self explanatory
c. Employee requested a hearing – self explanatory
d. Hearing held – self explanatory
e. Decision for creditor component – self explanatory
f. Other – self explanatory
SECTION 5: CREDITOR COMPONENT INFORMATION
a. Name – Creditor (HHS OPDIV)
b. Address – HHS OPDIV complete mailing address
c. Accounting classification – complete accounting classification that the overpayment will be
collected into
d. Document number, optional
e. Certifying Official – Name and signature and telephone number for questions.
PS05-09.2 Page 15 of 18

PS05-09.2 Page 16 of 18

Attachment D
SAMPLE
DEBT COLLECTION LETTER FOR SEPARATED EMPLOYEES
Each Payroll Office
Letterhead here
(2A)Name
(2B)Street
City, State Zip
(1)DATE: Month date, year
Dear Name:
An overpayment record has been generated on your pay account for pay period(s) ending
________________(20). The gross amount of your overpayment (including pay, all taxes, benefits and
other deductions) is ____________(5). The overpayment is the result of
__________________________(4).
Under the provisions of 31 CFR 901.2, payment of this debt is due within 30 days from the date of
this letter. You may remit the repayment in the net amount of $__________(6) by check or money order
payable to DFAS-CL DSSN ____________________(7), along with the payment coupon at the bottom of
this letter to ____________________(8).
If you do not repay the debt in full within ___(9) days it will be forwarded to the Office of
Personnel Management (OPM) or the office that handles your agency’s ‘out-of-service’ debts for further
action.
We encourage your prompt payment as in accordance with 4 CFR 102. 13 and 31 USC 3717,
interest at the Treasury tax and loan rate, penalties and administrative fees, may be assessed from the date
of this letter on any part of the debt not paid within _____(9) days of the date of this letter.
You may request copies of records we hold pertaining to your debt by contacting this office.
If you have any questions about your debt you may contact your timekeeper for time and
attendance corrections, or your personnel office for changes in personnel items or allowances. For general
questions your Customer Service Representative (CSR) can either assist you or contact this office to obtain
information relative to your needs. Your CSR cannot answer questions on debts more than 12 months old.
Contact the payroll office Customer Service Desk, at (comm phone number), DSN (DSN prefix)(14) for
action.
You may also request a waiver of repayment of the debt if you acknowledge the validity of the
debt, but believe you should not be required to repay it. Although collection of your debt may continue
after receipt of your waiver request, any amount collected by this office that is later waived will be
refunded to you. Detailed guidance regarding waiver of claims for erroneous payments under the authority
of 5 USC 5584 are contained in regulations of the employing agency.
___________________ new fill-in-the-blank contains the agency’s web site.
Sincerely,
PS05-09.2 Page 17 of 18

(Signature Name)(15)
Supervisor, Debt Processing
_______________________________________________________________________
Please remit with payment:
Name___________(2A)___________________________ SSN____(17)____ PayBlk_(18)___ Code_(19)_
Debt Dates_______(20)________ Debt Type_____(4)_____________ Creation Date ____(3)____
Sequence Number___(21)______
LOA__________(22)______________________________________________________
______________________________________________________________________
Payment Amount Enclosed $______(23)____________.
PS05-09.2 Page 18 of 18